The Microscopic Anatomy And Clinical Application Of Occipital Artery

Posterior circulation ischemia(PCI) is relatively insufficient blood supply in vertebral basilar artery system, which can cause posterior circulation transient ischemic attack, cerebral ischemic stroke and vertebral basilar artery thromboembolism disease, etc. PCI is one of clinical ischemic cerebrovascular disease, which show the dizziness, unclear vision, ataxia, dysphagia, dysarthria, and even show the serious clinical symptom such as disturbance of consciousness.To severe vertebral artery and basilar artery stenosis, about 20% cases have the risk of cerebral infarction, which mainly due to vascular structure changes of the posterior circulation vascular stenosis, occlusion, even cause brain hypoperfusion, and induce a series of clinical symptoms.In 1976, Ausman etc, had accomplished the occipital artery ? cerebellar artery anastomosis for the first time, and during the next ten years,he and his team had conducted in the occipital artery ? vertebral artery anastomosis; Frisoni and his team had reported that the patients with vertebral artery blood supply deficiency almost all were in the 1, 2 section, and so could consider that occipital artery and vertebral artery 3 section anastomosis did noncraniotomy; In china, LI Men also adopted the occipital artery ? the posterior inferior cerebellar artery anastomosis to cure the aneurysm in cerebellar artery. But, at present, the surgical procedure has not been popularized in clinical, and still less used in the actual clinical application of circulating vascular remodeling after surgery in treatment of posterior circulation occlusive vascular disease. There is little large randomized controlled clinical trials to confirm its curative effect.The recent study show that the section of occipital artery from the occipital artery sulcus to occipital through the deep fascia is suited for vascular anastomosis. At the same time, this section of artery can pull to any parts of the vertebral artery segments 3 end for anastomosis, and the artery is the ideal artery anastomosis of blood supply arteries. The infarction in the middle cerebral artery, the 3,4 section of vertebral artery and the basilar artery all can consider that the occipital branches occipital artery anastomoses the cortical branch of the middle cerebral artery or the posterior inferior cerebellar artery, so as to improve the state of ischemia brain tissue.Objective: 1 To study the anatomical structure of the occipital artery and its relation with surrounding tissues, which provide the anatomical basis for clinical posterior circulation ischemic cerebrovascular disease and posterior circulation aneurysms operation; 2 To observe the feasibility of the occipital artery and vertebral artery anastomosis; 3. To observe the feasibility of the occipital artery and the posterior inferior cerebellar artery anastomosis through far lateral surgical approach.Methods: 1 Take the use of 15(30 sides) perfused with colored silicone adult corpse head, occipital artery and its surrounding structures were dissected to observe and measure the occipital artery route, diameter, main branch, variation, blooding range, the anastomosis with neighboring vascular and the relations of occipital artery and peripheral cutaneous nerve; 2 On the 15 head simulating the far-lateral surgical approach for the posterior cycle cerebrovascular disease, rehearsed and summarizes the skills corresponding the skull base surgery, experience the specific process steps of the approach, and recording with photographic; 3 Observe, measure and record the datas of the 30 cases of normal people’s occipital artery and far-lateral approach; 4 Discusse the specific Significance of the Occipital artery for the treatment of cerebrovascular disease of the posterior cycle, and combined with far-lateral approach to summarize the specific applicability of this approach. 5 The clinical case discussion occipital artery surgery in the treatment of ischemic disease and circulation artery bypass adjuvant therapy PICA aneurysm clinical significance.Results: 1 Our study shows that the occipital artery origin the paries lateralis of the external carotid artery,and distribute the skin of the occipital. To choose a relatively stable three points on the specimen:the beginning part of the occipital artery, the segment of occipital artery groove and the segment of its superficial fascia. We measure the outside diameter of occipital artery found that the beginning part of the occipital artery is most wide(2.73 ± 0.48mm). The pettiest external diameter of the horizontal segment of the vertebral artery is 3.74 ± 0.12 mm. At the same time, the length of the clinical use of artery and vascular anastomosis distance length also can be used, and has found the occipital artery and vertebral artery measured level of pipe diameter is feasible for anastomosis.2 the datas about the occipital artery measured in the progerss: The outside diameter of the beginning part of the occipital artery 2.73 ± 0.48 mm,the segment of occipital artery groove in the outer diameter of the midpoint is 2.53 ± 0.40 mm, the segment of its superficial fascia at the point is 2.15 ± 0.26mm; the length between the occipital artery in the occipital artery groove midpoint and the wear out the deep fascia superficial point is 66.35 ± 1.19mm; the length between the occipital artery groove midpoint and the atlas, axis transverse foramen midpoint is 28.65 ± 2.29mm; the length between the midpoint of the occipital artery groove and the vertebral artery wear the atlant-ooccipital is 25.67 ± 1.18 mm; 3 The measurement of the horizontal segment of the vertebral artery on people-related: between the atlas transverse hole is 3.79±0.1 4mm; the diameter of vertebral artery through the membrane at atlantooccipital is 3.74 ± 0.12 mm; the length of the horizontal segment of the vertebral artery is 19.92 ± 1.37 mm. 4 The result show that the end-to-side anastomosis of the occipital artery and vertebral artery is vascular filling in good condition, and the magnetic resonance perfusion imaging and postoperative angiography all showed the vascular filling in good condition in postoperative.5 The result show that the end-to-side anastomosis of the occipital artery and the posterior inferior cerebellar artery is vascular patency, and filling in good condition through far lateral surgical approach.Conclusions: 1 The occipital artery can be used for the revascularisation in the patients with posterior circulation ischemic cerebrovascular diseases or posterior circulation aneurysms;2 clinical case- occipital artery feeding arteries after vascular anastomosis, has greatly improved the clinical symptoms of posterior circulation ischemia patients, improve the quality of life of patients for surgical treatment provides a valuable circulation ischemia information, but also for the origin of the posterior circulation aneurysms treatment provides a new way, through clinical cases confirmed occipital artery can provide adequate after vascular blood flow.